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192144 11/23/2010 "wF CITY OF CARMEL, INDIANA VENDOR: 357004 Page 1 of 1 ONE CIVIC SQUARE KONICA MINOLTA BUSINESS SOLUTION CARMEL, INDIANA 46032 DEPT CH 19188 CHECK AMOUNT: $256.62 +a, o PALATINE IL 60055 -9188 CHECK NUMBER: 192144 Ipry G CHECK DATE: 1112312010 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 601 5023990 216253083 256.62 MATERIALS SUPPLIES Invoice Number: 216253083 Please Remit To: 17 w KONICA MINOLTA BUSINESS SOLUTIONS Invoice Date: 11/12/2010 USA INC Page 1 of 1 DEPT. CH 1.9188 Subject to E.D. 112478 and the regulations KONICA MINOLTA PALATINE, IL 60055 -9188 of the Secretary of Labor on Affirmative For Billing Inquiries Call: 317- 870 -7000 Action and Equal Opporturnity CORPORATE DUNS No. 00- 1.70.7322 FEDERAL DUNS No. 62- 657 -8041 INVOICE Bill To: Ship To: CITY OF CARMEL WATER DISTRIBUTION CITY OF CARMEL WATER DISTRIBUTION 3450 W 131ST ST MICHELLE BREEDLOVE WESTFIELD IN 46074 3450 W 131ST ST WESTFIELD IN 46074 Purchase Order Nbr Delivery Nbr Sales Order Nbr Date Account Nbr P.O 1112KMB 3006735764 311599646/ 11 /12 /201.0 295718 /295718 Cartons Tot Weight Carrier Shipping Point Terms of Payment Comments 1 3.900 UPSG 140 NET 30 DAYS Quantity Quantity Quantity Ordered BackOrdered Material Nbr Description Shipped Unit Net Price Amount lZ3F85270351130849 1391311009542/FAX2900 2 4518826 TN110 TONER 2 EA 126.00 252.00 CARTRIDGE SUBTOTAL 252.00 FREIGHT 4.62 TOTAL NBR OF UNITS 2 TOTAL AMT 256.62 VOUCHER 103358 WARRANT ALLOWED 354781 IN SUM OF KONICA MINOLTA BUSINESS�SOL DEPT CH 19188 PALATINE, IL 60055 -9188 OPERA-60NS Carmel Water Utility ON ACCOUNT OF APPROPRIATION FOR Board members PO INV ACCT AMOUNT Audit Trail Code 21 6253083 01- 6200 -06 $256.62 Voucher Total $256.62 Cost distribution ledger classification if claim paid under vehicle highway fund Prescribed by State Board of Accounts City Form No. 201 (Rev 1995) ACCOUNTS PAYABLE VOUCHER CITY.OF CARMEL An invoice or bill to be properly itemized must show, kind of service, where performed, dates of service rendered, by whom, rates per day, number of units, price per unit, etc. Payee 354781 KONICA MINOLTA BUSINESS SOLUTIONS Purchase Order No. DEPT CH 19188 Terms PALATINE, IL 60055 -9188 Due Date 11/18/2010 Invoice Invoice Description Date Number ©r note attached invoice(s) or bill(s)) Amount 11/18/201( 216253083 $256.62 I hereby certify that the attached invoice(s), or bill(s) is (are) true and correct and I have audited same in accordance with IC 5- 11- 10 -1.6 Date Officer